The most densely populated state includes too few doctors among its closely packed citizens. And that has New Jersey policymakers acting with added urgency on the worsening shortage of physicians, a statewide problem that is hitting southern counties particularly hard.
Experts trace the shortage to a number of factors at various levels of the system. For one thing, there’s an insufficient number of available slots in New Jersey’s medical schools. For another, med students that complete their training face burdensome loan repayment. The New Jersey Council of Teaching Hospitals consortium also warns that New Jersey is losing doctors to other states because of what it terms a “hostile practice environment” characterized by the high cost of living, high taxes and the high price of medical malpractice insurance.
“Doctors are forced to make medical decisions with an eye on the hypothetical jury box,” said Assemblywoman Amy Handlin (R-Monmouth), co-sponsor of a bipartisan bill (A 1982) aiming to address issues of liability, insurance and litigation. A similar bill (S 760) has been put forth in the senate.
"One of my top priorities is to create a better medical practice environment in New Jersey that will help us cultivate, attract and retain the best physicians," Health and Senior Services Commissioner Poonam Alaigh said in a statement. She has announced the creation of a task force to look into developing new approaches to solving the problem.
But how well such measures can address the situation may be less important than how soon. Afrom the Council of Teaching Hospital notes that except for Camden, every county south of Burlington and Ocean already falls below the national average of 88 primary care physicians per 100,000 residents. The report further warns that by 2020, the statewide deficit of doctors could reach 2,800.
For patients, that would mean even longer delays in getting appointments, and the likelihood of having to travel out of state for certain kinds of care, according Dr. J. Richard Goldstein, president of the Council of Teaching Hospitals.
“If the shortfall isn’t reversed, said Thomas Cavalieri, dean of the School of Osteopathic Medicine at the University of Medicine and Dentistry of New Jersey in Stratford, “we could in 10 years be facing a very serious problem.”
The shortage of doctors in New Jersey is reflective of a general trend nationwide, and it stretches beyond primary care to cross about two dozen specialties, including pediatric internal medicine and geriatric medicine.
But the pain is being felt most in South Jersey, which experts say has a number of cards stacked against it, from its largely rural geography to its aging population.
Maybe more significant is that the School of Osteopathic Medicine is the region’s only medical school. While it has increased enrollment over the last two years by 50 percent—to 150 students—it has not been able to meet the demand of an applicant pool of 4,000. In short, the area needs to produce more doctors: According to the Council of Teaching Hospitals, the amount of education and training a physician receives in a state appears to increase the likelihood he or she will practice there. Cavalieri said it’s also been shown that medical school graduates are more likely to practice close-by to where they completed their residency.
Similarly, the majority of New Jersey’s nurse practitioner programs are clustered in the northern and central parts of the state, said Maryjoan Ladden of the Robert Wood Johnson Foundation. If enough nurse practitioners were being trained locally, they could help alleviate the physician shortage, especially in primary care, she said.
South Jersey is set to get a boost in medical education slots in 2012 with the opening of the Cooper Medical School of Rowan University. The Camden school, which would be the first four-year allopathic institution in South Jersey, is expected to welcome an inaugural class of about 50 students. (Allopathic schools issue MDs; osteopathic schools issue DO degrees.)
Even with the growth in medical education opportunities, it’s New Jersey’s overall practice environment that has others concerned.
Under-compensation is one issue. According to Statehealthfacts.org, a, project of the Henry J. Kaiser Family Foundation, New Jersey’s physicians receive much lower Medicaid fees than the national average. Loan repayment is another. Doctors who practice in certain states may qualify for loan forgiveness; while some states offer numerous such opportunities, New Jersey offers relatively few.
“People are leaving because they have high student loans,” Cavalieri said. “They can… more easily join a hospital system in a region where they may have loan forgiveness.”
High taxes are another disincentive for many medical school graduates. However, State Sens. Ronald Rice (D-Essex) and Joseph Vitale (D-Middlesex) have sponsored a bill that encourages new doctors begin their practice in New Jersey by softening the tax blow. It would allow qualified physicians to deduct from gross income the first $200,000 of income earned over seven years.
Of course, the highest visibility issue is medical malpractice insurance and litigation, and it’s also receiving the bulk of the political attention.
Experts say New Jersey’s rates for medical malpractice insurance are among the highest in the nation. For example, the states OB/GYNs pay the seventh highest liability insurance premiums in the country, while premiums in other specialties are similarly high.
The bipartisan bills in the legislature address some of these issues. They propose a two-year time limit for filing most medical malpractice lawsuits, setting standards for expert testimony, protecting health care professionals against civil damages under certain circumstances when providing emergency assistance, limiting liability insurance premium increases, and setting requirements for the awards for the awards of liability damages.
Other policy initiatives to address the shortage are also in the works. OB/GYN and pediatrics have the lowest retention rates in New Jersey of any physician subspecialty, and the Women’s Legislative Caucus held a hearing this month on the impact of this fact on women’s health. Participants reviewed the impediments to practicing medicine in New Jersey and are expected to develop bipartisan legislation as a result.
Additionally, the Council of Teaching Hospitals has called for the establishment of a state “Center for Medical and Health Workforce Planning,” which Goldstein described as a clearinghouse to coordinate the efforts of hospitals, medical schools and policy makers. It would gather data and monitor the situation in the workforce and also establish a recruitment center and a forum for the establishment of new policies for workforce planning in this area. The council recommended the center could align goals among the medical schools, teaching hospitals and the state.
The council’s January report also recommends enhanced state funding for graduate residency programs, an increase in medical school capacity, and the creation of financial incentives. These include the expansion of loan redemption programs for physicians and grants to schools and hospitals that encourage retention of graduating doctors.